Tuesday, February 9, 2016

Two  Health Care Alternatives
What’s the alternative?  That’s the perpetual question asked when faced with difficult questions.
After writing over 4000 blogs and six books on health reform over the last 10 years,  I have come to the following conclusion.
There are two alternatives.  Why don’t we stick with both? Progressives could keep their piece of the health care cake, while conservatives could retain their slice.
·         Top-Down Government-Driven  Care
One is top-down government care as exemplified in Medicare and Medicaid.    These two programs now cover 125 million Americans (55 million in Medicare, and 70 million in Medicaid), and they are certain to grow as our population ages and if our economic growth remains stagnant.   I would  not include the PPACA (Patient Protection and Affordability Care Act), or ObamaCare,  in this alternative, because it has neither protected the majority of Americans nor made their care more affordable.   The PPACA, however,  has lowered the uninsured rate to 9.1%. That’s  a good thing.   Medicare and Medicaid has done well  for  the old and low-income  income patients,  have been established for 50 years, and are politically popular  and impossible to end.  Let’s keep them largely intact. My only suggestion for maintaining their sustainability  is that we edge up entry into Medicare by 2 years or so, and hand over Medicaid management to the states, each  of which has a unique set of problems. 
·         Bottom-Up  Market-Driven Care
Here  I suggest a new program. We could call it  FMCACA (Free Market Choice and Affordability Care Act).    It is based on the philosophy of Milton Friedman (1912-2006), who explained, “So that the record of history is absolutely clear.  That there is no alternative way, so far discovered, of improving the lot of ordinary people that can hold a candle  to the productive activities that are unleashed in a free enterprise society.”   This Act would free people to choose what manner of care they desire.   It would consist of these components:  larger risk pools to help lower premiums,  freedom of choice of doctors and health plans, health savings accounts expansion,  universal health care tax credits, portability of plans across states, state flexibility in managing Medicaid populations,  tort reform to lower malpractice expenses,  and less bureaucratic intervention into doctor-patient relationships.    This act would  stand in contrast to top-down government elitist  policies, which advocate,  fixed global payment rates,   control of population health through data monitoring,   alternatives to fee-for-service payments, competitive bidding for all services, centrally controlled, health  exchanges,  one size-fits-all administrative structures for all providers,  full transparency of prices, more care by non-physicians, banning of physician self-referrals,  reducing costs of defensive medicine.     These policies would continue to apply to the Medicare and Medicaid populations.  Unfortunately,  the policies would accelerate physician shortages and limit patient choices and freedoms.


Given these two alternatives, which they will pursue anyway,  Americans should be free to partake in the  most affordable and convenient care, whether that care be centrally planned or  market-driven.

Sunday, February 7, 2016

To Conserve, As in Conservatism
To keep from loss, decay, waste, or injury; preserve.
Definition, To Conserve

 I view the word conservative as a derivative of the word conserve. We want to converse our money. We want to conserve our wealth. We want to conserve. We want to be smart. We want to be smart where we go, where we spend, how we spend. We want to conserve our country. We want to save our country. And we have people that have no idea how to do that and they are not doing it, and it’s a very important word and it’s something I believe in very, very strongly.

Donald Trump,  GOP Debate, February 6, 2015
Donald Trump  made a good point in last night’s GOP debate when he traced the derivation of  the noun “conservatism” to  the verb “ to conserve.”

Cast in this derivative light, “conservatism” has merits.
Its aim is “to conserve” what’s good about America and what contributes to its strength as a nation.
Conserving America is best achieved  by conserving.
·          Reliance on  truths of the Constitution with its emphasis and Checks and Balances of three branches of government with freedom of choice and liberty for all. 

·          Preservation  of traditional American values – self-responsibility,  marriage and family,   religious faith, and government for the people, for the people, and by the people. 

·         Equal opportunity for all, as opposed to equal outcomes for all. 

·         The power  of free market enterprise from the bottom-up  rather than on federal coercions  and regulations from the top-down.
·         The elixir of economic growth as the best means of lifting the most people up and relieving poverty for most, while providing for those truly in need.

·         The freedoms to speak one’s mind with straight talk, unvarnished truths, without undue concern about political correctness, of fear of offending someone,  somewhere, somehow.

Saturday, February 6, 2016

Opioid  and Heroin Addictions and Deaths a Major Political Issue in New Hampshire
What’s the number 1 political issue in New Hampshire  prior to to the February 8 primary elections? 
It’s  the exploding number of deaths from opioid and heroin overdoses.  This year these deaths are on track to exceed 400.  In Manchester, the state’s largest city at 110,000, there have been 700 overdose calls and 85 deaths.  On Manchester restaurant  has called authorities to report 134 customers suffering from overdoses.
Why is New Hampshire the epicenter of narcotic deaths?  No one seems to know.   New Hampshire is a relatively affluent state with a predominantly white population.  Most of the death have occurred in young white men.  Does New Hampshire  have a high number of dealers?  Does the small size of the state make distribution easier?   Most people seem to agree the low cost of oxycontin , priced at $90 to $100 per 30 mg pillm  may contribute?   The increasingly lower price of heroin, coupled with its increased purity and its being cut with the analgesic  Fentangl  may be a factor.
Most politicians agree the solutions  to the growing problem, which  has doubled in scope in the last year,   resides in better treatment facilities and identifying dealers.   Doctors are on the alert and are lessening the number of opioid prescriptions for pain.  But the problem is mainly on the streets,  not from doctor prescriptions,  and from the low costs and high potency  of these drugs.     And there is now no doubt that opioid use often leads to heroin addiction (Wilson Compton, MD,  “Nonmedical Prescription  Opioid s and Heroin Use, “ NEJM, January 14, 2016).

Friday, February 5, 2016

ObamaCare Heads Towards the Cliff
Will ObamaCare survive?  Can it be sustained?  If not, why not, who’s to blame, and what’s next?
Questions swirl around ObamaCare’s future,  as UnitedHealth, Aetna, Cigna , and Humana threaten to jump off the health exchange cliff.  The reasons are obvious.  United has lost  $750 million on the exchanges,  $425 million  in 2015, and Aetna has dropped $100 million.  United says it will lose $500 million more in 2016.  These health plans are for-profit enterprises, and they cannot sustain these losses for long,  stay in business, and satisfy investors and other stakeholders.   Add to this the fact that ½ of not-for-profit health exchange co-ops have failed, and the possibility that the GOP may win the Presidency, the House, and the Senate,  and the cliff’s edge looms closer and closer.
Who’s to blame?  The failure of the young and healthy, aged 19 to 34,  to follow the ObamaCare script are taking the hit.  Last year,  the CBO predicted  20 million would sign up for the exchanges, but only 12.7 million did.  The inevitable result was that premiums had to be jacked up for older and sicker patients, or for-profit insurers would have to exit the market. 
The Obama administration assumed the young, facing individual mandate penalties and a short sign-up period, would rush to sign up.   The administration was wrong.   The young knew a bad deal when they saw one,  calculated they had more to gain and less to lose  by not signing up,  and, due to "special enrollment" exemptions , could wait until they were sick to sign on the dotted line.
Who’s  the villain ?   The for-profit insurers, says Bernie Sanders,  the Democrat socialist.   If these insurers  and the for-profit motive did not exist, this problem of insurance losses would not be there.   The solution is Medicare-for-All with elimination of for-profit insurers.   Raise taxes on the rich and middle-class, and let the government  and all the taxpayers take the loss.    Universal coverage is a moral obligation, even if it would cost $15 trillion over the next decade.  Apparently,  the young and healthy agree with Senator Saunders.   Polls indicate 84% agree with him.

Thursday, February 4, 2016

Facts about Physician Assistants

·         Eugene Stead, MD, Professsor of Internal Medicine at Duke,  assembled first class in 1965.


·         There are now 108,500 PAs.   67% are women, 87% are white,  and their average age is 38, and 22% speak another language than English.


·         There are 199 programs across U.S.   Requires Masters degree to enter.  


·         Nationally certified and state licensed.


·         Under physician supervision, can conduct physical exams, order tests, diagnose illness, develop treatment plans,  perform procedures,  order preventive tests, assist in surgery.


·         Help relieve physicians  of time-consuming burdens.


·         Earn $95,000 on average, or $45 per hour, and have debts of $112,500.


·         Profession growing fast, one of most desirable jobs in numerous surveys.


·         Accepted well by physician supervisors and patients.

Wednesday, February 3, 2016

ObamaCare Is Silent Campaign Issue for Now But Not for Long
These days , during the early stages of a hectic political campaigns, you just hear much about ObamaCare.   Politicians are simply too busy trying to get elected or to keep from getting rejected.  ObamaCare is  too deep and complex an issue to win or lose voters on for now. For the moment, it is best to praise the Lord and hold the ammunition.
But just  wait until income taxes become due and premium increases become known.   Those who choose not to have a plan  will learn it will cost them roughly a $1000.  And premiums overall will go up more than 10% in 29 states  with surges up to 30% or more in half a dozen states.   Increases in individual markets will average 14.7% (“ObamaCare’s Wallet Buster Health Plans,” WSJ, February 2, 2015).
As one cynic observed, “ When they have you by your wallet,  your heart and mind will follow.”  This line of thinking will play in the GOP’s favor, which is why the party voted to repeal ObamaCare even  when it knew it could not override President Obama’s veto.    Democrats are lukewarm about ObamaCare and are promising they will “fix it.”  Cynics may say the voters know the price of everything but the value of nothing.  But price will be an issue in the wake of Obama’s promise that his plan would reduce premiums by $2500 by 2016. 
2016 is here.  The economy is weak,  the stock market is sputtering, and middle class voters are holding onto their wallets.